SERVICE CHECK-IN

SERVICE CHECK-IN
DATE / TIME*
MonthDayYear
Date
Hour MinutesAM/PM Option
SERVICE LOCATION*
Southeast Dallas / Pleasant GroveLancaster
CUSTOMER INFORMATION
REASON FOR VISIT*
Just here for an OIL CHANGEHere dropping off my vehicleHere and waiting on repairs to be completedGoing to be dropping my vehicle offHaving my vehicle towed to your service centerOther (Describe Below)
IMPORTANT NOTE: You have indicated that you are having your vehicle towed to our service center. If you are using our tow company, or if we are the ones initiating the tow for you, you will be charged for towing fees unless the the repair is covered by your limited warranty.
ADDITIONAL NOTE: Warranty repairs only cover towing up to 100 miles. If your vehice is being towed from a location more than 100 miles from our servcie center, you will be charged the difference between 100 miles and the actual miles, regardless of whether the repair is covered by your limited warranty.
Initial Below Acknowledging that you have read the above important notes related to towing fees you may be responsible for.
Initials*
DESCRIBE OTHER*
FULL NAME*
First and Last
CELL PHONE*
Please enter a valid phone number.
EMAIL*
example@example.com
ACCOUNT # OR LAST 4 OF SOCIAL*
ARE YOU AN AUTO CITY ADVANTAGE PLUS MEMBER?*
YESNONOT SURE
VEHICLE INFORMATION
YEAR*
MAKE*
MODEL*
COLOR*
CURRENT MILES*
REASON(S) FOR DROPPING OFF
Please describe in as much detail as you can, what issue(s) you would like addressed.
If you have more than one, PLEASE PUT EACH ITEM IN A SEPARATE BOX
ISSUE #1*
ISSUE #2
ISSUE #3
ISSUE #4
ISSUE #5
ISSUE #6
Has our service center looked at ANY of these issues in the last 3 months?*
YESNO
Check all that apply:*
Issue #1 was looked at in the last 3 monthsIssue #2 was looked at in the last 3 monthIssue #3 was looked at in the last 3 monthIssue #4 was looked at in the last 3 monthIssue #5 was looked at in the last 3 monthIssue #6 was looked at in the last 3 month
ADDITIONAL COMMENTS (OPTIONAL)
VEHICLE PHOTOS
WOULD YOU LIKE TO ATTACH PHOTOS OF YOUR VEHICLE BEFORE LEAVING IT AS EVIDENCE OF IT'S CURRENT CONDITION?*
YES (Use Photo Tool Provided Below)NO - I am waiving my right to make a claim for damages
PHOTOS OF VEHICLE EXTERIOR
- Click the button below to open your camera app
- Turn your phone sideways
- Take a photo of all four sides of the OUTSIDE of your vehicle
Be sure to capture all four sides and stand close enough to see any dents or scratches.
FRONT*
DRIVER'S SIDE*
REAR*
PASSENGER SIDE*
INTERIOR
- Click the button below to open your camera app
- Take photos of the INSIDE of your vehicle as you walk around it. Be sure to capture the front seats and the back seats.
FRONT SEATS
BACK SEATS
ACKNOWLEDGEMENTS
MAKING PAYMENTS
I acknowledge that my installment contract with Auto City & Concorde Auto, requires that my account must remain CURRENT even while my vehicle is in service and that failure to do so, may cause repairs to be delayed or cancelled altogether.
Initials*
FUEL REPLACEMENT
I understand that fuel used in the diagnosis and repair of my vehicle WILL NOT BE REPLACED.
VALUABLES
I have REMOVED ALL VALUABLES from the vehicle, and acknowledge that Auto City is not responsible for lost or stolen articles left behind.
PERMISSION TO OPERATE VEHICLE
I hereby grant Auto City and Concorde Auto Acceptance and their employees or agents, permission to OPERATE MY VEHICLE on streets, highways, or elsewhere for the purpose of testing and/or inspection.
CHARGE FOR RE-ASSEMBLY
I understand that my vehicle must be disassembled to access a repair, and if I chose not to have the repair made at the time of service, I will be charged the labor cost to reassemble the vehicle.
WARRANTY DEDUCTIBLE
If repairs are covered by my limited warranty, I understand that I may be charged a deductible of $100 which must be paid when picking up my vehicle.
DIAGNOSTIC FEE
If repairs are not covered by my limited warranty, I agree to pay a $97.50 check out fee to diagnose my vehicle, which must be paid when picking up my vehicle.
MECHANIC'S LIEN
An Express Mechanic Lien is hereby acknowledged on the above vehicle to secure the amount of repairs. This also applies to any auto towed to Auto City when a signed repair order was not written but by verbal phone authorization was given.
TEXT UPDATES
I agree to receive updates about the progress of repairs, and/or other relative information relative to my repairs via Text to the number shown above. Texting fees from my carrier may apply.
I, {fullName} do swear and affirm that all the information provided above is true and accurate to the best of my knowledge.
CUSTOMER SIGNATURE
Clear
Should be Empty:

SERVICE CHECK-IN

ACKNOWLEDGEMENTS